Two cases of wide QRS complex tachycardia caused by anamorelin.

Anamorelin is prescribed for cancer cachexia treatment. Anamorelin is a ghrelin receptor antagonist and exerts a sodium channel blockade effect, possibly inducing disorders of the cardiac conduction system. We herein report two cases of wide QRS complex tachycardia caused by anamorelin. In both cases, the patients had liver dysfunction. Anamorelin is mainly metabolized in the liver; hence, sodium channel blockade by anamorelin during liver dysfunction can cause serious side effects, including wide QRS complex tachycardia, similar to flecainide toxicity. The differential diagnosis of wide QRS tachycardia caused by anamorelin can be challenging because conventional electrocardiogram criteria cannot be applicable in patients with drug intoxication. It can worsen the situation for the use of antiarrhythmic drugs for wide QRS tachycardia. The appropriate treatment is supportive care until anamorelin is metabolized. To our best knowledge, this is the first study to report the life-threatening adverse effects of anamorelin. Learning objective: Anamorelin is prescribed for cancer cachexia treatment. Anamorelin can cause wide QRS complex tachycardia. Our findings in the two cases we encountered indicate that we should be aware of wide QRS complex tachycardia in patients taking anamorelin, especially if they have liver dysfunction. We should suspect the condition to be the adverse effect of anamorelin and monitor the electrocardiogram and blood test findings regularly to prevent this fatal side effect.

Operative Procedure of Anterior Commissure for Type II Thyroplasty.

OBJECTIVE: We reviewed the clinical anatomy of the anterior commissure and examined the effectiveness of a specialized spreader developed for optimal, efficient spreading of the thyroid cartilage in type II thyroplasty. STUDY DESIGN AND METHODS: The present study was a multicenter retrospective study of patients with spasmodic dysphonia who underwent a primary operation either before or after the introduction of a specialized spreader (in 2008 or 2014, respectively). In these patients, we examined the size of the titanium bridge used, the presence of perforation of the mucosa directly superior to the anterior commissure, and postoperative glottic findings. RESULTS: The sample comprised 39 and 40 patients who underwent surgery in 2008 and 2014, respectively. The mean size of the titanium bridge used during surgery was significantly smaller in 2014 (2.9 mm) than in 2008 (3.81 mm). Perforation of the laryngeal mucosa occurred in 13 patients in 2008 but occurred in only one patient in 2014. Based on glottic findings, spreading the thyroid cartilage using the specialized spreader was deemed to yield an effective glottic gap. CONCLUSIONS: In type II thyroplasty, the handling of the anterior commissure is the most important point. It is necessary to split the tendon and to spread the glottis while the tendon is joined with the cartilage. For this purpose, a specialized spreader was made. The use of a specialized spreader renders separation around the anterior commissure unnecessary, enabling minimally invasive spreading of the thyroid cartilage and thereby improving phonation.

[Intraoperative CT Is Useful in Diagnosing a Fish Bone Foreign Body Buried in the Tongue: A Case Report].

Fish bones as a foreign body are often present in the palatine tonsil and the base of the tongue. Such foreign bodies can often be diagnosed with inspection only. However, it is difficult to diagnose and extirpate a foreign body when it is buried in the oral/pharyngeal mucosa. We experienced a case of a fish bone foreign body buried in the tongue muscle layer. We report herein on the case of a 49-year-old man with a fish bone foreign body buried in his tongue. The patient had noticed a sore throat since eating a sea bream and was referred to our department. Visual inspection revealed no foreign body, but CT imaging revealed a fish bone in the tongue. We performed an emergency surgical exploration of tongue to locate the fish bone. Because the fish bone as a foreign body was unable to be confirmed by palpation, we identified the location of the fish bone by intraoperative CT. This is a rare case of a fish bone buried in the tongue muscle layer, and intraoperative CT was useful in identifying the positon of the foreign body.

[Multiple myeloma recurring as small intestinal polyposis after autologous hematopoietic stem cell transplantation].

A 52-year-old woman was diagnosed with BJP-λ multiple myeloma (MM) in November 2012. She was treated with six cycles of bortezomib and dexamethasone, resulting in a very good partial response. The patient underwent autologous peripheral blood stem cell transplantation (PBSCT) 6 months after the diagnosis, and clearly achieved a complete response thereafter. She again suffered chronic abdominal pain with spontaneous remission 9 months after the PBSCT, and, 2 months thereafter, was hospitalized due to intestinal obstruction. Two small intestinal intussusceptions and polyposis in the small intestine were found on abdominal computed tomography. As conservative treatment produced no improvement, partial resection of the small intestine was performed. The pathologic review clearly demonstrated the polyps to have atypical plasma cell infiltrates in the mucosa of the small intestine involving all layers. Immunohisto-chemistry and FISH analyses yielded positive results for CD138, CD79a, and λ light chain, consistent with extramedullary relapse of MM. It is very rare for MM to present with polyposis in the small intestine. There have been no reports describing such a case after autologous PBSCT.

Aggressive giant cell reparative granuloma of the nasal cavity.

Giant cell reparative granuloma (GCRG) is an uncommon and nonneoplastic reactive tumor that involves the maxilla and mandible in the region of the head and neck. It is rare in the nasal cavity, and it might be misdiagnosed. We reported a very aggressive GCRG with intracranial invasion, which was treated surgically via a combined approach of a lateral rhinotomy with a craniotomy by bilateral coronal incision. The pathology was consistent with GCRG. A short literature review about diagnosis, clinical behavior, and treatment of this tumor entity is given.

[Case of papillary carcinoma of the thyroid gland with concurrent tuberculous lymphadenitis].

We report a case of papillary carcinoma of the thyroid gland and cervical lymph node metastases with concurrent tuberculous lymphadenitis that was diagnosed preoperatively. A 35-year-old woman presented with multiple lymph node swellings and an anterior neck mass. No findings suggesting the coexistence of pulmonary tuberculosis were present. The patient underwent a total thyroidectomy with bilateral neck dissection together with medication. Measures to prevent tuberculosis were undertaken during the perioperative period. The histopathological diagnosis was papillary carcinoma with both metastatic and tuberculous lymphadenitis of the lymph nodes in the neck. The possible coexistence of tuberculous lymphadenitis must be ruled out when lymph node swellings are observed in patients with head and neck cancer, including thyroid carcinoma.

Descending necrotizing mediastinitis from deep neck infection.

This study aims to identify predisposing characteristics of descending necrotizing mediastinitis (DNM) arising from deep neck infection (DNI) and to determine appropriate therapeutic intervention strategies. We retrospectively reviewed 54 patients (male, n = 34; female, n = 20; mean age, 64.5 years) who had been treated at Mie University Hospital for DNI between April 2001 and October 2011. Eight of nine patients who developed DNM confirmed by computed tomography of the neck and chest, underwent mediastinal drainage (video-assisted thoracic surgical drainage, n = 6; mediastinoscopy-assisted drainage, n = 2). A patient developed uncontrolled acute respiratory distress syndrome after aggressive surgery, resulting in a mortality rate of 12 %. High blood CRP values, and the pharynx and tonsils as origins of infection were factors involved in the development of DNM arising from DNI. In conclusion, DNM remains a destructive and fatal disease that requires aggressive treatment including mediastinal exploration.

Effects of a novel nonantibiotic macrolide, EM900, on cytokine and mucin gene expression in a human airway epithelial cell line.

BACKGROUND/AIMS: Long-term macrolide therapy is an effective treatment for chronic sinusitis and diffuse panbronchiolitis. However, long-term use of macrolides may promote the growth of drug-resistant bacteria; therefore, development of macrolides with no antibacterial action is desirable. A new erythromycin (EM) derivative, (8R,9S)- 8,9-dihydro-6,9-epoxy-8,9-anhydropseudoerythromycin A (EM900), does not possess antibacterial action. METHODS: To determine whether EM900 induced a clinically relevant anti-inflammatory response and repressed mucin gene expression in cells derived from human airway epithelia, we assessed the effects of EM900 on IL-1ß-induced inflammatory cytokines in A549 cells and MUC5AC gene expression in HM3-MUC5AC cells. We also investigated the effects of EM900 on IL-1ß-induced NF-κB activation. We performed reporter gene assays and quantitative PCR in A549 and HM3-MUC5AC cells. RESULTS: Both EM and EM900 suppressed IL-1ß-induced IL-8 expression in A549 cells. EM900 also suppressed IL-1ß-induced IL-1ß and TNF-α expression in A549 cells. EM900 inhibited IL-1ß-induced MUC5AC expression in HM3-MUC5AC cells. Both EM and EM900 suppressed IL-1ß-induced NF-κB activation in A549 cells. CONCLUSION: This study demonstrated that EM900 suppressed the induction of inflammatory cytokines and MUC5AC gene expression in cells derived from human airway epithelia, and our findings indicate that these effects may be mediated by the suppression of NF-κB activation.